Absolute surgical indications include irreducibility, vascular injury, open injury, compartment syndrome, and inability to maintain reduction with nonoperative methods. When there are no indications for emergent surgical intervention, reduction, immobilization, and MRI can be performed followed by delayed surgical intervention.
Delaying surgery for 7 to 14 days will allow for appropriate vascular monitoring and reduction of swelling. This period will also allow for some capsular healing, which allows the use of arthroscopically assisted techniques with less risk of fluid extravasation. In cases in which collateral ligaments repair is indicated, surgery should not be delayed beyond 3 weeks as scar ring will obscure tissue planes and repair of individual structures will be difficult.
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